Can Crohn’s Disease Be Cured?

At present there is no treatment that can be guaranteed to get rid of Crohn’s disease (CD) for good. However, that is far from the whole story. With the right treatment most people can settle their symptoms, heal the inflammation in the bowel and remain well for months or years at a time. This is called remission, and it is the aim of all treatment for CD.

What is remission?

Remission means that the disease is no longer active. Doctors describe it in two ways:

• Clinical remission: your symptoms, such as diarrhoea, pain and tiredness, have settled.
• Mucosal healing: the lining of the bowel looks healed when it is examined with a camera (colonoscopy), and tests such as faecal calprotectin are normal.

Symptoms can settle while some inflammation remains, so your IBD team will usually want to check that the bowel itself has healed. People whose bowel has healed are less likely to have a flare-up, to develop complications or to need surgery.

How is remission achieved?

There are three main approaches, often used together.

1. Diet. A liquid diet taken in place of all food for a few weeks settles CD in most people. Foods are then reintroduced one at a time to find out which ones cause trouble. In our experience most patients who complete this process remain well, and after some years many find they can eat normally again, the disease having apparently burnt itself out. See Elemental and Polymeric Diets and The Dietary Treatment of Crohn’s Disease.
2. Medicines. Steroids are used to settle a flare-up, while immunosuppressants such as azathioprine and biologic medicines such as infliximab and adalimumab keep the disease quiet over the longer term. See Medicines for Crohn’s Disease and Ulcerative Colitis.
3. Surgery. Removing a badly damaged or narrowed section of bowel can give years of good health, but it does not cure CD. The disease often returns, usually where the bowel has been joined, which is why treatment is normally continued afterwards. See Surgery in Crohn’s Disease.

Which approach is best depends on the person, the part of the gut affected and how active the disease is. This is discussed in Should I go for drugs or diet?

Why is ulcerative colitis different?

Ulcerative colitis (UC) affects only the large bowel, so an operation to remove the colon (colectomy) cures the bowel disease, although it is a major step and usually only taken when other treatments have failed. CD can affect any part of the gut from the mouth to the anus, so no operation can remove it completely. See Differences between Crohn’s Disease and Ulcerative Colitis.

Staying well

There is a good deal you can do to help keep CD in remission:

• Stop smoking. Smoking makes CD more active and roughly doubles the chance of needing surgery. Stopping is one of the most effective things you can do. See Smoking and Crohn’s Disease.
• Keep taking your treatment, even when you feel well. Stopping maintenance treatment is a common cause of flare-ups. Always talk to your IBD team before changing anything.
• Avoid foods you know cause trouble, and make sure the rest of your diet is nutritionally complete. A dietitian can help.
• Avoid anti-inflammatory painkillers such as ibuprofen and naproxen, which can trigger a flare-up. Paracetamol is usually safe.
• Keep your follow-up appointments and blood tests, so that any return of inflammation is picked up and treated early. A symptom diary can help you notice changes.

What about cures I have read about?

Many products are sold online as cures for Crohn’s disease, including herbal remedies, supplements and special diets. None has been shown in proper clinical trials to cure CD, and some can interact with your medicines or cause harm. If you would like to try something, discuss it with your IBD team first, and never stop your prescribed treatment in favour of it. See Alternative Medicine.

Will there be a cure in future?

Research into the causes of CD, including the part played by the bacteria in the gut and by the genes that make some people more likely to develop it, is moving quickly. New medicines are approved every few years, and some people now reach remission who would not have done so a generation ago. Treatments such as stem cell transplants are being studied for the most severe cases, but they carry serious risks and are not a routine option. A true cure is not yet in sight, but the outlook for people with CD has never been better.

Most people with Crohn’s disease lead full and active lives: working, travelling and raising families. If your disease is not well controlled, ask your IBD team about the options that might suit you.